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Data Story

Optimizing the Use of Gastroscopy for Otherwise Healthy Patients with Dyspepsia

Summary

Dyspepsia occurs in 20% of the population and referrals to Gastroenterology for dyspepsia are common, leading to significant demand for specialty care for this condition.  While endoscopy is an accurate test for diagnosing dyspepsia, clinically significant findings are very rare in patients < 55 years of age.  The intent of the project is to review the use of endoscopy to investigate healthy young patients with dyspepsia and ultimately to improve access to endoscopy in Calgary.

EGDs on dyspepsia patients <55 years of age in Calgary hospitals
EGDs on dyspepsia patients <55 years of age in Calgary hospitals

Data analysis identified significant practice variation (IQR 20% - 50%).

Background

Esophagogastroscopy (EGD) is a common procedure performed by Gastroenterologists; however, a significant number of these examinations are completely normal. A consistent lack of findings on any invasive examination should call into question the appropriateness and utility of the test. It has been clearly documented that performance of EGD for patients with dyspepsia does little to reassure them in the long-term, and does not improve patient quality of life nor symptoms, as it is a diagnostic test and not therapeutic.  There is an opportunity to optimize the use of EGD resources for healthy patients with dyspepsia in the Calgary Zone.

Methodology

Ethics approval was obtained from the Conjoint Health Research Ethics Board at the University of Calgary. EGD reports and pathology for procedures performed for dyspepsia at four Calgary hospitals were evaluated (April 1-June 30 in 2015, 2016, 2017). Only procedures after clinic consultation were included.

Laboratory, billing data, and consultations with GI physicians helped to identify criteria to whittle the cohort down to the lowest yield EGDs.  

Physicians consented to receive individual reports with peer comparators and participated in a facilitated audit & feedback session in March 2018.  Physicians who participated were also asked to complete a Commitment to Change form identifying up to 3 concrete actions that they could take to reduce low yield EGDs.

Lessons Learned

Co-designing the program with GI physicians and champions strengthened the criteria for low yield EGDs and aligned the report content with physician needs.

Adopting a methodical recruitment strategy and including the audit and feedback session as part of a QI-focused retreat yielded a high rate of participation from the Division physicians.

Next Steps

Work is underway to follow-up with the Division of GI on a number of the ideas for reducing low yield EGDs suggested during the audit and feedback session.

PLP is planning to complete a second data pull in late 2018 to assess the number of low yield EGDs in Calgary. 

References

Choosing Wisely Canada

Five Things Physicians and Patients Should Question